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Medicare COVID-19 Telemedicine Factsheet

The COVID-19 outbreak has not only disrupted daily life across the globe, but the contemporary healthcare model as well, with an urgently needed shift to digital medical solutions. Federal regulations are changing continuously, insurance coverage has greatly expanded, and the use of telemedicine is growing at a tremendous rate assisted by new policies and a widespread loosening of restrictions previously impeding access to care.

As part of the battle against the novel coronavirus pandemic, the Centers for Medicare & Medicaid Services (CMS) have expanded access to Medicare telehealth services on a temporary and emergency basis and lessened HIPAA enforcement effective as of March 6, 2020. These updates offer Medicare beneficiaries – many of whom are at an increased risk for serious COVID-19 illness – a safe, alternative model of care in the form of a wider range of remote services. During the COVID-19 crisis, innovative uses of telemedicine technology are driving routine care, keeping vulnerable demographics safe, and expanding access to health care. 

“The benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19  – are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus,” a statement from the CMS on the promotion of telemedicine reads. Further information about the newly implemented guidelines for patient care and their implications on telehealth services during the COVID-19 outbreak are outlined below.

Expansion of Telehealth Services

1135 Waiver

As part of the program, the 1135 waiver was introduced to lessen prior restrictions and promote wider access to remote care. Prior to the waiver, Medicare was only able to pay for telehealth on a limited basis, for example, when a patient was receiving care in a designated rural area or when received the service in a healthcare facility. Under this waiver, the following changes have taken effect:

•   Office, hospital, and other telehealth visits will now be covered and reimbursed for the same amount as an in-person visit.
•   A wide range of providers can offer telehealth services across the nation, including nurse practitioners, psychologists, and licensed social workers.
•   Medicare beneficiaries are now be able to receive a wider variety of services through telemedicine – such as evaluation and management visits, mental health counseling, and preventative health screenings.
•   The HHS Office of Inspector General is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs during this time.

Virtual Services 

Medical professionals can provide their Medicare patients with a range of virtual services as part of the telehealth program, including Medicare telehealth visits, virtual check-ins, and e-visits. Specific requirements for each service are outlined below.

Medicare Telehealth Visits

Throughout the course of the COVID-19 outbreak, Medicare patients may use digital technology for office, hospital visits, and other services previously rendered in-person. The recent changes include:

•   A wider range of practitioners is now able to get payment covered for telemedicine services – including physicians, nurse practitioners, physician assistants, midwives, anesthetists, psychologists, clinical social workers, registered dietitians, as well as nutritional professionals.
•   Virtual visits will now be paid at the same rate as regular, in-person visits.
•   Providers must use an interactive audio and video system permitting real-time communication during Medicare telehealth visits in order to be reimbursed appropriately.
•   New CMS guidelines remove the requirement of an established patient-provider relationship for the duration of the public health emergency, further details below.

“The Department of Health and Human Services (HHS) is announcing a policy of enforcement discretion for Medicare telehealth services furnished pursuant to the waiver under section 1135(b)(8) of the Act.  To the extent the waiver (section 1135(g)(3)) requires that the patient have a prior established relationship with a particular practitioner, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency,” the CMS statement reads.

Virtual Check-ins

In all areas of the country, Medicare beneficiaries will be able to have brief online check-ins with practitioners – or brief communication technology-based services. Policy changes related to this include:

•   Medicare will now pay for virtual check-ins for patients with established relationships with their physicians to prevent unnecessary travel and office visits.
•   Brief virtual check-ins can be conducted using a broader range of communication methods than Medicare telehealth visits; medical practitioners may bill for virtual check-in services provided via several telecommunication technologies – including telephone, audio/video, secure text messaging, email, and patient portals.
•   Services cannot be related to a medical visit within the previous 7 days or lead to a medical visit within the following 24 hours, or the soonest available appointment.
•   Patients must verbally consent to receive virtual check-in services.
•   Patients can submit video/images using store and forward methods to be interpreted by physicians within 24 business hours.
 

E-Visits

As part of the updated guidelines, established Medicare patients in all types of locations can have non-face-to-face patient-initiated communications with their providers using online patient portals. These services can only be rendered in accordance with the following guidelines:

•   E-visit services can only be reported to Medicare if the billing practice has an established relationship with the patient.
•   E-visits must be initiated by the patient although, practices may educate patients on the availability of these services prior to their initiation.
•   Communications can occur over a 7-day period and only after the patient provides verbal consent to receive telehealth services.
•   These services may be billed using CPT codes 99421-99423 and HCPCS codes G2061.
More information on relevant billing codes for e-visits and other virtual care services can be found on the CMS’ website.

Health Insurance Portability and Accountability Act (HIPAA) Updates 

In addition to the amendments above, the HHS Office for Civil Rights will lessen restrictions and waive penalties in association with HIPAA compliance for health care providers that serve patients in good faith through virtual communication technologies during the COVID-19 outbreak. More information on the latest HIPAA updates can be accessed here.

Although Medicare already offers flexibility to states that wish to implement telehealth services, the most recent developments signal a major step forward in the direction of telemedicine, despite the temporary nature of federal guidelines. With the help of changes in regulations and the strategic expansion of telehealth, patients can now reach providers easily via a range of tele communication options from the comfort and safety of their homes, while medical professionals can readily provide care without reimbursement concerns. As the COVID-19 public health emergency continues to evolve rapidly, regulations and guidelines may change; clinicians are encouraged to stay up-to-date on the latest medical guidance.

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Self-Care Strategies For Medical Practitioners

As the population enters another month of social distancing and self-isolation in an effort to combat the COVID-19 outbreak, it is becoming increasingly important for individuals to prioritize their physical, mental, and emotional health. The so-called “new normal” many find themselves living in has been characterized by heightened stress levels, long work hours, increased feelings of loneliness and hopelessness, as well as a persisting need to support and care for loved ones. During such an overwhelming time, it is important to take the necessary self-care measures that can work to mitigate negative emotional and physical responses to the pandemic – many of which may be happening subconsciously.

Both deteriorating physical and mental health can impede the ability to provide much-needed medical and home care, give and receive support, and to fulfill the needs of a growing number of patients. Whether you are one of the healthcare providers braving the crisis and fighting the virus on the front lines, a first-time telemedicine practitioner, or a medical professional with a practice currently closed, it is essential to take the time to incorporate some of the self-care strategies listed below when possible.

Self-Care Strategies

Boosting both physical and mental health requires regular check-ins throughout the day. Make sure to check in not only with your family and friends, but equally as importantly with yourself – how are you feeling physically, mentally, and emotionally? Paying attention to your current state will help identify what you may need at that moment, whether that is a walk around the neighborhood, a nutritious meal, or some physical exercise. The recommendations below are simple to incorporate into a daily routine yet may prove tremendously effective in improving overall wellbeing.

Physical Health

Supporting physical health is vital to ensure a well-functioning immune system and to protect it from the risk of COVID-19 infection. Several ways to maintain a healthy lifestyle despite the circumstances – inclusive of regular physical activity and a well-balanced diet – are listed below:

•   Maintain a sleeping schedule and get enough rest; aim to sleep for around 7 to 8 hours per night.

•   Engage in physical activity every day – this can include walks around the block, jogging, or exercising at home.

•   Spend time outside (following social distancing guidelines) and in nature; studies have found that being outdoors is one of the quickest methods of improving health and wellbeing.

•   Eat regularly and fuel your body with a healthy, nutritious diet.

•   Make sure to hydrate as dehydration can have noxious effects on physical health; aim for about 2 liters of water per day.

•   Avoid substance use and destructive behaviors; abusing alcohol or drugs at this time may worsen both physical and mental health, take a toll on the immune system, and lead to other repercussions.

Mental Health 

Taking care of your mental health is equally as important; the heightened stress levels and rising feelings of loneliness can contribute to declines in immune system functioning as a result of related hormonal changes.

•   Find ways to connect with yourself and those around you – this can include regular phone or video calls, communicating throughout the day, and mindful personal check-ins.

•   Set a routine and try to maintain it; devoting specific times of the day to work, chores, home life, and self-care can help provide much-needed structure.

•   Instead of worrying about the public health crisis at hand, focus on things you can control, including work-related tasks, healthy lifestyle habits, and time spent connecting with the people around you.

•   Consider introducing relaxation techniques throughout the day, such as deep breathing, stretching, meditation, and yoga practice.

•   Use technology mindfully; many individuals are increasingly turning to social media, television, and their computers as a way of spending idle time. While it is needed to maintain social interactions and continue business operations, the amount of unnecessary time spent in front of a screen should be minimized.

•   Listen to music, read books, and pursue other stimulating activities instead.

•   Explore online resources and applications for managing anxiety and other mental health concerns at this time; the CDC has compiled a list of helpful coping strategies, accessible here. 

To be best equipped to provide health care and other support services, medical practitioners must prioritize their physical health and emotional wellbeing, which can be extremely difficult for those working within the healthcare system. While the consistent efforts of healthcare practitioners of all backgrounds are invaluable, the demands of the oft-dysfunctional healthcare system can take a significant toll on their physical and mental health. Many are struggling with traumatic stress responses or battling the infection themselves. As integral members of our shared communities, medical workers are encouraged to remember that they are not alone and to seek the therapeutic support and medical care they need.

Regardless of specialty, finding the time to practice self-care is now more important than ever; introducing some of the above strategies into your daily routine can significantly improve overall health and wellbeing. Additional recommendations, including specific tips for first responders and health care providers, have been made available by the CDC and can be found here.

If you or someone you know is considering suicide please contact the National Suicide Prevention Hotline at 1-800-273-8255 or through chat on https://suicidepreventionlifeline.org/

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Choosing the Right Telemedicine Provider for Your Practice

Recent changes to the practice of medicine are evident; no longer are patients coming in for routine appointments, follow-up visits, or elective procedures. Many patients and practitioners are opting for the use digital health services, while some individuals are refusing to seek needed care out of virus-spurred fears. Alongside a marked decrease in demand for in-person care has been a significant rise in telemedicine use – the number of online visits in March surged by up to 50% per data from Frost and Sullivan consultants.

With the widespread adoption of telemedicine, healthcare market analysts now anticipate to see the general number of medical care visits rise above 200 million – up from the 36 million predicted for 2020 – and estimate all virtual health encounters will surpass 1 billion by the end of the year.

A multitude of software developers has already begun capitalizing on the occasion by developing new technological solutions and telecommunication platforms to fulfill the rising demand for online medical services. Meanwhile, to ease the implementation of telehealth across specialties, federal regulations have been amended relaxing HIPAA enforcement rules, mitigating reimbursement barriers, and making other helpful policy changes. However, the widespread lessening of restrictions has also prompted cybersecurity concerns as a result of an increasing number of users sharing their protected health information and personal data online. Due to time constraints and a rushed speed of market entry, many of these novel software solutions are lacking in safety certifications and robust testing.

Changes in Telemedicine Regulations

Now that the U.S. Department of Health & Human Services’ guidance allows HIPAA-covered entities to “use any non-public facing remote communication product that is available to communicate with patients,” providers are turning to common audio or video communication technologies. Broadening access to remote care, the agency now permits providers the use of programs such as Apple’s FaceTime, Facebook’s Messenger video, and Skype. The agency notes, however, that patients should be made aware of the potential cybersecurity and data privacy risks associated with these platforms as they are not intended for telehealth-specific use.

“This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19,” the HHS outlined in a statement.

Evaluating Telemedicine Providers

Faced with a seemingly abundant amount of telehealth vendors, healthcare providers may find it difficult to determine which one will best fulfill the needs of their practice. Many may already have embedded telehealth functionality via their electronic health record (EHR) vendors or their employing organization; these solutions can allow for seamless integration into practice, be cost-saving, and tend to have proven safety records. For practitioners seeking new telehealth vendors, the selection process may be daunting although the steps outlined below can help navigate the crowded landscape of telemedicine providers.

Finding and Understanding Your Options

In beginning the search for a telehealth provider, physicians should focus on narrowing down the possible options by outlining their practice’s key criteria and goals. The evaluation of potential vendors must take into account these values and should focus on the perspective of a long-term partnership, not just that of a transactional business. The goal of integrating a telehealth provider into your practice is to develop a long-standing relationship with them in order to have an expert resource on hand, guaranteed support throughout the introduction process and beyond, as well as a reliable, secure platform for your patients.

Researching potential telehealth services and their reviews is a critical component of selecting a vendor, however, it may be challenging to choose from the 900+ platforms available. Asking for word-of-mouth referrals and recommendations from your professional network can often help narrow down a list of possible telehealth vendors. Practices can also consider consulting the American Telemedicine Association or their state medical association for further suggestions.

After sufficient research, medical providers should select a shortlist of a few quality vendors and schedule calls with each one to discuss their service offering, policies, and compliance with stat guidelines. It is also important to incorporate legal feedback and security standards when evaluating potential partners to assure any potential liabilities are minimized.

Finally, upon selecting a few prospective vendor candidates, practitioners should develop a Request for Proposal (RFP) that clearly outlines their goals and share it with the vendors that best align with them.

 

Getting to Know the Platform and Team

After receiving and reviewing RFP responses, providers and medical practices should ask telehealth vendors for case studies and referrals to determine whether they can be considered safe, reputable sources. Scheduling time to speak with product engineers and existing customers can help physicians obtain a more realistic understanding of how the platform could function in their daily practice.

The next important part of the selection process is familiarizing yourself with the platform itself as well as the vendor’s customer service team – which you will be primarily communicating with. To do this, healthcare providers should schedule live demos of the software and informational calls with the vendor team. During these interactions, physicians should focus on evaluating the software across the six key factors outlined below in order to determine whether the service will adequately address their practice’s needs.

Six Key Factors for Evaluation

Business

Important aspects of the vendor’s business to keep in mind include: tenure, funding source, financial stability, notable customers, and other affiliations. Practitioners are also encouraged to consider the company’s business model, product cost, reimbursement rates, risk sharing, and payment program options to approximate their return on investment. Does the vendor have expertise in offering telehealth to other practices in your specialty? Are they aware of federal and private insurance requirements? These are also questions to assess while investigating potential vendors.

Information Technology

From a technical perspective, the ability of the program to be integrated within a practice’s current IT landscape – and the EHR system in particular – can have a significant impact on decision making. As does the cost, process, and timeline of implementation, all of which are important factors to consider in the current environment. Other valuable considerations include: patient geolocation for licensure requirements, patient access to data, customization capabilities, biometrics/RPM integration capabilities, and the impact of regular use on internet and local network usage.

Security

With cybersecurity threats currently at an all-time high, security guarantees offered by telehealth vendors are paramount. In evaluating a potential telemedicine provider, physicians should ensure it complies with HIPAA and local regulations, has a clear liability structure in place for managing potential data breaches, and is transparent about its data use practices. Other important security factors include user authentication and authorization systems and whether it has in-platform patient consent capabilities.

Usability

The usability of the product itself is one of the most essential factors for consideration in choosing a telehealth vendor. During live demos, healthcare providers should note their personal reflections on user experience – will it be easy to use for other care team members and patients? How long does it take for the platform to launch? How many steps are required to launch the application? Other factors for consideration here are: dashboard/workflow assimilation, multi-specialty application, patient and care team engagement metrics, as well as billing and payout processes.

Customer Service

Another key variable to evaluate when selecting a telemedicine provider is the quality of the company’s customer service. Medical practices and professionals should consider the level of support that would be available to them during and after service integration, which can include staff training, patient education, project, management, data analysis, and many other practice-enhancing features. In addition, the vendor should be able to provide an adequate degree of technical support for patients who may need assistance with setting up the platform, accessing it from different devices, and troubleshooting IT issues.

Clinical Validation

The final factor healthcare practitioners should guarantee is the clinical validation of their chosen telehealth technology; this can be done by requesting any available documented clinical outcomes as well as published peer-reviewed research.

Test the Product

After selecting a telemedicine solution that best suits their medical practice, healthcare professionals are urged to test the technology with either a patient advocate, member of a patient advisory board, or other staff member to ensure it can be successfully implemented. Some platforms and services may prove to be too complicated for patients to use, requiring more time spent on training and technical assistance rather than offering an efficient method of digital care delivery.

 

Setting your practice up for success in the digital space requires careful consideration of a variety of factors, most notably the 6 key conditions outlined above. In addition, selections of telehealth vendors must be made in accordance with state and federal regulations; medical offices and health organizations can consult practices on the requirements and help them narrow down available options. Furthermore, risk and liability mitigation is essential to a safe online practice – clinicians are encouraged to incorporate legal feedback and cybersecurity best practices to mediate any potential threats.

To further assist practices and providers in determining which telemedicine service is right for them, Healthcare IT News has published an ongoing list of telehealth vendors and their service offerings, accessible here.

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